Megavejiga obstructiva en pediatría: el estreñimiento como causa oculta de daño renal. Reporte de un caso Obstructive megabladder in pediatrics: constipation as a hidden cause of kidney damage. A case report

ABSTRACT Bladder-bowel dysfunction is a common and underdiagnosed condition in pediatrics. The coexistence of chronic constipation and urinary incontinence can contribute to elevated intravesical pressure, vesicoureteral reflux, recurrent urinary tract infections, and progressive kidney damage. Case Report: A 5-year-old female preschooler from a rural Andean area presented with chronic constipation, persistent urinary incontinence, and multiple episodes of fecal impaction without specialized follow-up. She was admitted for a distal fracture of the left radius and ulna; during the evaluation, abdominal distension with a palpable infraumbilical mass was noted. Imaging studies revealed fecal impaction, megabladder, bilateral ureterohydronephrosis, grade V left and grade IV right vesicoureteral reflux, post-void residual urine, diffuse megacolon, and sigmoid dolichocolon. He presented with recurrent urinary tract infections caused by Klebsiella spp. A renal scintigraphy with 99mTc-DMSA showed differential function of 94% in the right kidney and 6% in the left. A left nephrectomy and urological reconstructive surgery were performed, with subsequent progression to chronic kidney disease. Conclusions: Persistent vesicointestinal dysfunction may represent a high-risk nephro-urological condition. Early recognition of constipation and urinary incontinence is essential to prevent irreversible kidney damage.